|
* Required
Field
So We Can
Contact You ...
*Street Address:
City:
St: Zip:
*Email
Address:
*Home
Tel# (include area code):
Cell# (include area code):
Tell Us About
Yourself ...
Select shirt size:
(Note: you will need to
own at least 2 'server shirts' by the server
meeting)
Your
Age:
Have
you served with us before?
Yes No
If yes,
when?
What
Church Do You Attend:
Who Referred
You:
Please
tell us of any special needs, including lodging,
medical and meals:
Emergency
Contact
Information
Emergency Contact Person:
Relationship:
Phone# (include area
code):
How Will You
Pay?
|
*Please select
your payment option: |
|
|
A $50 deposit is due
when you register. The full balance of $135 is due
two weeks before the retreat date. If you
are paying by check, please make your check
payable to "The Living Sanctuary Church". All payments are
non-refundable and non-transferable, as reservations are made
immediately upon receipt of registration
form. If you have a question, you can
contact us by phone at 941-365-LIFE or by email
by clicking <here>
.
*Please Enter Your
Initials To Confirm That You Read This
Section: |
Please Sign
Application ...
Note: if you are
completing this form for someone else, please
make sure that they are aware and approve!
*Please Enter Your Name (person
filling out the form):
*Today's Date
(mm/dd/yy):
If the applicant is 18 or
younger, you must have your parent's or
guardian's approval to attend an Encounter
weekend ... please enter your initials to
confirm you have done so:
We're Almost
Done ...
Please review your
data before clicking on the Send
button
We recommend that you
print this page before you submit it ...
PRINT NOW
|